Editorial

Humbled and Dismayed, But Strengthened

Politics Gone Viral

While not fully appreciated or acknowledged—and despite mystifying obstacles— dentists have provided a blueprint for how to safely navigate a pandemic.

Society’s response to the COVID-19 pandemic has humbled and dismayed, but strengthened the dental profession. Humbled to helplessly observe state-of-the-art science struggle to treat and prevent the disease and to discover the depths of unpreparedness and mismanagement of many of our institutions. Dismayed that, in some states, particularly New York, our political leaders failed to trust the profession of dentistry to make the final call on the timing of our ability to safely return to the delivery of comprehensive services after prolonged restrictions. Strengthened, as a result of our courage initially to place the public good above selfinterest and voluntarily limit the scope of our practices and the evidence that will again confirm dentists’ competence to safely render all aspects of oral healthcare during a pandemic.

For several weeks after our self-imposed and necessary suspension of elective care, practicing dentists stood equipped to safely render comprehensive care. During this time, organized dentistry diligently communicated evidence of its readiness to the office of the governor, his “Reopening New York” task force, the Deputy Majority Leader of the Senate, Speaker of the House, members of the State Senate and Assembly, Department of Health and county officials, on multiple occasions and on various platforms. We repeatedly called on the governor to rescind his emergency order limiting dental practice to emergency and urgent care, but to no avail. Our profession received no cogent explanation for the unwarranted delay in reopening. In fact, we received no response at all from our state government, which, in effect, locked itself down when dentists and the public most needed decisive action. As a result, state mandates blindly forced dentistry to the sidelines as one of the few groups of medical professionals precluded from exercising its professional judgment for the full benefit of patients for too long. Ultimately, in order to force the state’s hand, the New York State Dental Association made the unilateral assertion that, despite not being part of a phase, dentists would reopen as a professional service in Phase 2, since continuing the restriction was arbitrary and capricious. Almost immediately thereafter, the governor rescinded his executive order and sanctioned our reopening.

Whether related to the ongoing COVID-19 pandemic, a second wave or future crises, our political leaders could learn from the dental profession’s response over the past few months. Dentists respected and relied upon the knowledge and expertise of the scientific community and the evidence it generated regarding the virus and dentistry’s own past history of success in safely rendering care during prior pandemics to guide our decision-making. We created more stringent infection-control guidelines and embraced protocols from all relevant agencies to prepare dental practices for a safe return to comprehensive care. We courageously refused to succumb to unfounded panic and fear when society needed us to perform at a high level. Our lawmakers and leaders must remember our state educates, trains and licenses dental professionals precisely to make these evidence-based decisions on the safe rendering of oral healthcare. Politicians waste a valuable resource and deny the public an essential service when they override the professional judgment of their own experts trained for this very purpose.

The state political machinery, in ignoring our profession’s position, relied upon two fatally flawed premises. First, that the only way to protect the public health during a pandemic is by shutting down most of the economy, including the healthcare professionals who support the public’s health. Second, that the only way to protect the economy, including dental practices, requires sacrificing public health. 1 Overreaction as a response to underpreparation is still overreaction and a mistake that creates new dilemmas without solving the original problem. We, as a country, do not close other areas of society to deal with inherent risks. We do not shut down the roads because people die in traffic accidents. We do not prohibit air travel due to the risk of death in plane crashes. We do not lock down hospitals because patients acquire and die from hospital-related infections. 2 Rather, we call on our ingenuity to develop stringent standards and successful preventive protocols. We trust trained professionals with proven track records to act responsibly in the face of the specific challenge. Finally, we enforce accountability to comply with these measures. We always have a choice on how to respond to risk. As we continue to navigate the COVID crisis, or in any future pandemic, our leaders must refocus their mindset away from tactics that force dentists and patients to stay at home to measures that facilitate dentists’ ability to continue to render comprehensive care.

Overbroad and destructive shutdowns create unnecessary risks to the oral and general health of our patients and to the financial viability of our practices that, together, outweigh the risks of the disease. A “one-size-fits-all” lockdown ignores the evidence that individuals are not equally susceptible to severe COVID symptoms. “In New York as of May 28, 2020, almost 40% of the 23,700 reported deaths occurred in people over 80.” 3 Narrowly tailored restrictions that protect vulnerable populations with compromised immune responses would more effectively reduce fatalities, with less collateral damage. This applies even more when dealing with a profession such as dentistry, which has a history of successfully dealing with prior pandemics and has authored national and state comprehensive plans for reopening offices for all dental services. In fact, studies show the actual risk of developing infections in dental practices appears very low. 4 Hence, during a pandemic, most dentists can safely treat most patients for most conditions utilizing their professional judgment.

Regretfully, in this instance, dentists’ autonomy became a casualty of political panic. Panic grounded, not on a legitimate respect of the virus and its unknowns, but on our leaders’ self-interested fear of losing political power and influence as a result of any blame the government could incur if dental offices somehow, against the weight of all prior evidence, became hotspots for transmission of a viral disease. Even worse, panic based on a fear that, as politicians, they would lose their newfound emergency authority, which they opportunistically use to advance their own political and social agendas in areas unrelated to the pandemic. Finally, the most destructive, panic designed to incite fear in the public through government and media outlets to compel compliance with overbroad and unsubstantiated restrictions. This fear further threatens our public health when it misleads patients to postpone routine care which, when left untreated, causes preventable pain, damage and infection that will require more invasive and costly treatment.

Organized dentistry must counter statistics flooding media outlets designed to promote unfounded fear. We need to document the inequities suffered by our patients and our profession as a result of draconian shutdown mandates and report the lack of evidence of virus transmission in dental offices to the public and government officials. The media’s broadcast of the number of COVID cases, hospitalizations and often misleading number of deaths in the daily newspapers and on the nightly news, like running statistics of a football game, fans the flames of fear. It irresponsibly and opportunistically uses the victims to paint a distorted picture of reality, since it publishes the raw numbers without the caveat that they are arbitrarily coded and fraught with inaccuracies. Washington State included five deaths from gunshots in a group of approximately 1,000 deaths. 5 In addition, most distribution channels failed to put these occurrences into context with the collateral and unnecessary damage caused by the prolonged lockdown response to the virus. Dentistry should compile the following statistics and communicate them to the public and our government leaders:

• Number of coronavirus infections transmitted between dentists, auxiliaries and patients and cross-transmissions among dental patients….. None documented.

• Number of undiagnosed cases of oral cancer and other oral diseases and pain, damage and infections due to delay of what was labeled as “nonessential” treatment… Too numerous to count.

• Number of dentist and auxiliary layoffs, lost jobs, forced retirements, bankruptcies and dental office closures… Too numerous to count.

New York’s response to the pandemic called for, at most, a three- to four-week pause in comprehensive dental care, only to conserve PPE and reserve hospital facilities and services for COVID-19 patients. Our leaders’ misconceptions and fears overcame their duty to act in the best interests of the public. As a society, we must ensure our lawmakers and politicians refuse to panic again in the face of a similar future challenge. Dentistry, while dismayed that we put our trust in our leaders, and our leaders failed to reciprocate, stands empowered by its own response.

REFERENCES

1. Roy A. Reopening the US economy even if the pandemic endures. Wall Street Journal April24, 2020. https://www.wsj.com/articles/reopening-the-u-s-economy-even-if-the-pandemic-endures-11587740529.

2. Roy A. Round Table of the US Congress Senate Committee on Homeland Security & Government Affairs. COVID-19 How New Information Should Drive Policy. FREOPP.org. May 6, 2020. https://www.hsgac.senate.gov/imo/media/doc/Testimony-Roy-2020-05-06.pdf.

3. Berenson A. Unreported Truths about COVID-19 and Lockdowns, Part 1: Introduction and Death Counts and Estimates, 2020, citing https://covid19tracker.health.ny.gov/views/ NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Fatalities?%3Aenbed=yes&%3Atoolba r=no&%3Atabs=n

4. Laheij A, Kistler J, Belibasakis G, Välimaa H, Soet J. European Oral Microbiology Workshop (EOMW) 2011. Healthcare-associated viral and bacterial infections in dentistry. J Oral Microbiol Published online 2012 Jun 12. doi: 10.3402/jom.v4i0.17659, p.7.

5. Berenson A. Unreported Truths about COVID-19 and Lockdowns, Part 1: Introduction and Death Counts and Estimates, 2020, citing https://www.clarkcountytoday.com/news/ washington-department-of-health-clarifies-covid-19-death-numbers/

Dentistry after the Pandemic

Manuscripts Sought for Special Issue

The New York State Dental Journal is planning a special issue devoted to “Dentistry after the Pandemic.” It will be an exploration of the legal, regulatory and public health changes taking place in practice operations and transitions in the wake of the COVID-19 pandemic. The Journal is inviting submissions of original manuscripts for that issue, which is planned for early 2021. The deadline for submitting manuscripts is Oct. 31, 2020.

All submitted manuscripts will be subject to review by members of The Journal Editorial Review Board. Interested authors are advised to read the Author’s Guidelines, found in the Publications section of the NYSDA website, www.nysdental.org.

Please direct manuscripts and questions to Mary Stoll, managing editor, at mstoll@nysdental.org.